Failure to Provide Care and Interventions for Hand Contractures
Penalty
Summary
A resident with a primary diagnosis of Parkinson's Disease developed contractures in both hands, which were observed to cause pain and limit the ability to perform certain tasks. The resident reported that staff were not providing any interventions or therapy related to the contractures, and denied receiving services from physical therapy, occupational therapy, or floor staff for this issue. Review of the resident's records showed that earlier Minimum Data Set (MDS) assessments did not indicate any functional limitations, but a later MDS documented functional limitations in both upper and lower extremities, indicating the presence of contractures. The care plan for the resident included a focus on nutrition, noting the risk related to hand contractures and the offer of adaptive silverware, which the resident refused. However, there was no documented evidence of other interventions for the contractures. The care plan also addressed ADL assistance due to contractures, instructing staff to observe for decline and notify the physician or therapy as needed, but lacked specific interventions to address or monitor the contractures. Interviews with the physical therapist and DON confirmed that there were no current interventions in place to monitor or prevent worsening of the contractures, and there was no documentation of previous attempts or refusals of splint use.